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PERMIME NAME/ADDRESSpnet-l-FoNbryN..?L«otronl(D(f-mi) <br />NAME <br />ADDRESS <br />FACILITY <br />ii?ILt t?Jh:ti to >GMI!i <br />LOCATION ,k YnLi:,dLc CC of <br />r 7 ti(lh A T F- w V <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES/ OMB No 2040-0004 <br />DISCHARGE MONITORING REPORT (D RI <br />- n/ <br />PERMIT NUMBER DISCHARGE NUMBER <br />- IAA. <br />MONITORING PERIOD V i <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Ir»tructiorw before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />" f <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT T,.:. - C t 1 tt L ! : :: <br /> v M a <br /> <br />r SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />7 L L Ci <br />\ C / <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />z::•?; ?+ . ` <br />i : :' <br />' ` <br />- ., <br />. <br /> REQUIREMENT .. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT t c: t E tj h' <br /> REOUIREMENT <br /> j <br /> SAMPLE <br /> MEASUREMENT <br /> - <br /> PERMIT j 7 7 <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' Ceri'ty under Pe-all i v o law'hot this dorument and all atlarhments were <br />d <br />TELEPHONE <br />DAT <br /> prepare <br />under my dlnecilon or suPentfon In arcordanre with a system designed E <br /> to aaun that g..nn d personnel Pnoperiy Calker and e,.Just, the Information <br />submitted <br />Based on m <br />uir <br />f tl <br />In <br />e <br />erson <br /> . <br />y <br />q <br />y o <br />s <br />P <br />or Persons who manage the system, <br />th <br />d <br /> or <br />ose penoes <br />irertly responslbie for gathering the Informatlon, the Infoneulfon \ ' - <br />- - submitted ls. to the best of my knowledge and belief. Imse, amnralr, and -pit.' <br /> I am swans that there are dgnincaM Penalties for wbmilnng his Information. SIGNATURE OF PRINCWAL EXECUTIVE ' <br />TYPED OR PRINTED Inriuding the poaaiblllly of fine and Imprisonment for knowing rlolalloes. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-part form. PAGE OF <br />i <br />A 1